Part B Insider (Multispecialty) Coding Alert
NJ Doctor Sentenced for Billing 900 Endoscopies on One Patient
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Plus: Don't revert to 4010 form if you can avoid it. Wondering whether insurers are actually checking medical necessity for your procedures? One recent case suggests that they are watching carefully. A New Jersey-based otolaryngologist was sentenced last week to two years in prison for defrauding his insurer of over $725,000, an April 9 DOJ press release says. The physician admitted filing false claims for about 900 nasal endoscopies that he purported to have performed on a single patient over several years. The physician continued to file claims for services he said he performed on the patient even after the patient left the practice, and for dates of service when the doctor was out of the country. In addition to prison time, the physician must also pay restitution of $725,156 and surrendered his medical license, the DOJ release notes. To read the complete news brief, visit www.justice.gov/usao/nj/Press/files/Stein,%20Dr.%20Michael%20Sentencing%20News%20Release.html.
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